tathmini gbv : evaluating comprehensive gender-based violence program scale-up in tanzania susan...

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Tathmini GBV: Evaluating Comprehensive Gender-Based Violence Program Scale-up in Tanzania Susan Settergren Futures Group

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  • Slide 1
  • Tathmini GBV : Evaluating Comprehensive Gender-Based Violence Program Scale-up in Tanzania Susan Settergren Futures Group
  • Slide 2
  • Tathmini GBV USAID Project SEARCH IQC, Task Order 9 External evaluation of the PEPFAR GBV Initiative Implemented by Futures Group in partnership with Muhimbili University of Health and Allied Sciences (MUHAS) Pangaea Global AIDS Foundation Population Council 2
  • Slide 3
  • Key features Evaluation of the combined effects of a comprehensive program model that addresses GBV prevention and response services for GBV survivors Focus on intimate partner violence and on sexual violence against adults and children Rigorous study design that includes quantitative and qualitative measurement over time Stakeholder engagement throughout the project Translation of results for policy and program 3
  • Slide 4
  • GBV program model Facility-based services for GBV survivors Facility-based GBV screening and referral in clinical settings Clinic and community outreach Community-based GBV prevention activities Referrals to psychosocial support, legal services, and safe houses 4
  • Slide 5
  • Study location: Mbeya Region Form of GBVMbeyaAll Tanzania Ever experienced gender-based physical violence since age 15 1 48.8%38.7% Ever experienced physical violence often in the past 12 months 1 14.6%9.4 % Ever experienced sexual violence since age 15 1 14.6%20.3% Ever experience sexual or physical violence and told someone 1 16.7%10.1% Ever experience sexual or physical violence and sought help 1 36.8%46.6% Husband ever demonstrates controlling behaviors 1 37.8%35.1% Experienced sexual violence prior to age 18 2 - 28% of females 13% of males First sexual experience was nonconsensual (among those who had their first sexual experience prior to age 18) 2 - 29% of females 18% of males HIV prevalance 3 9.3% female 9.2% male 6.6% female 4.6% male 1 Tanzania DHS, 2010, which surveyed women ages 15 49. 2 National Survey on Violence against Children, 2009, which surveyed girls and boys ages 18 24. 3 THMIS, 2007-8. 5
  • Slide 6
  • Program implementation Roll-out of services by the Regional Medical Office under the new MOHSW National Management Guidelines for Health Sector Prevention and Response to Gender-Based Violence Adaptation of SASA! community mobilization approach led by locally-based NGOs Management and funding through the Walter Reed Program Tanzania 6
  • Slide 7
  • Conceptual framework GBV program Expected outcomes GBV services at health facilities Linkages among programs and services Community-based GBV sensitization and prevention programs Decrease in experience and perpetration of GBV Decrease in acceptance of GBV Increase in availability and quality of GBV services at health facilities Improved use of GBV services Improved access to quality GBV services through multiple entry points Increase in community knowledge of GBV Increase in community actions to reduce GBV Decrease in acceptance of harmful gender norms Other GBV services 7
  • Slide 8
  • Specific aims (1) Did the GBV program lead to increased care for GBV survivors? Primary outcome: Utilization of GBV services at health facilities Secondary questions Was the quality of GBV services at health facilities improved? Was GBV care more comprehensive both within and across health facilities and through referrals to services outside health facilities? Did the source of referrals to health facilities change over time? Was there an increase in knowledge within communities about health services for GBV? About other GBV services? Did communities take action (and, if so, what actions) to facilitate survivor access to GBV services? What are key barriers in access to services? Did this change over time? 8
  • Slide 9
  • Specific aims (2) Did the GBV program lead to a decline in GBV? Primary outcome: Recent experience of GBV (specifically, IPV and SV among women ages 15-49) Secondary questions Was there a decrease within communities in the acceptance of GBV? Was there an increase in community-led actions to stop GBV perpetration? Was there an increase in community-led actions to assist those at risk to prevent experience of GBV? Was there a shift in community norms toward greater gender equality? 9
  • Slide 10
  • HIV-related outcomes Did the GBV program contribute to increased utilization of HIV services including HIV counseling and testing, PMTCT, HIV care and treatment? Did the GBV program contribute to reduction in HIV risk behaviors and increase in protective behaviors? 10
  • Slide 11
  • Study design Pair-matched cluster randomized trial 6 intervention clusters: immediate rollout of GBV interventions in the community and at the health facilities 6 control clusters: rollout of GBV interventions delayed by 18 months Cluster definition One or more contiguous administrative wards surrounding a Health Center Sufficient geographical distance between clusters to minimize cross-cluster contamination 11
  • Slide 12
  • Data collection Health facility register review of GBV service delivery and referrals (adults and children) Household surveys of women, ages 15-49 Key informant interviews and focus group discussions with men, community leaders, other community representatives Health facility register review of GBV screening and referrals Health facility assessments Key informant interviews with providers of GBV services Exit interviews with health facility clients Routine M&E conducted by program implementers 12
  • Slide 13
  • Timeline Study protocol development and planning Feb 12 Aug 12Feb 13 Aug 13Feb 14 Aug 14 Feb 15 Analysis and dissemination Baseline data collectionEndline data collection I n t e r v e n t i o n p e r i o d MOHSW training curriculum development 13
  • Slide 14
  • Asante sana! 14